Improvement team | Examples of changes initiated (June 2011–Feb 2012) | Associated outcomes at intervention end (Feb 2012) | Average monthly number of doses of DPT antigens: comparing baseline with project implementation and follow-up periods (June 2010–May 2012) | ||||
---|---|---|---|---|---|---|---|
Antigen | HU typea | BL avgb | PIF avgc | Sigd | |||
Bukeeri | Reallocated existing budget to pay a local motorcycle driver to take staff to outreach sites to provide RI services; established partnerships between staff and VHTs to improve access to population; met with and engaged religious leaders | Four outreach sites opened and providing RI on a regular basis at times negotiated with community; VHTs mobilized mothers and visiting households to check status of child health cards; tally sheets and registration forms developed to monitor outreach | DPT3 | Static | 23.3 | 31.0 | p = 0.038 |
DPT3 | OR | 2.6 | 33.7 | p < 0.001 | |||
DPT1 | Static | 25.2 | 33.3 | p = 0.036 | |||
DPT1 | OR | 3.5 | 28.3 | p < 0.001 | |||
Butende | Incorporated VHTs into data collection and improvement process; changed existing staffing pattern to increase RI staff from one to two on RI days; improved staff arrival time at outreaches; directly involved VHTs in mobilizing families; met with religious leaders | VHTs now provide input to improvement process; VHTs making home visits to “difficult areas”; staff arrival time at outreaches becoming more consistent; in-charge actively working with religious leaders | DPT3 | Static | 4.8 | 8.7 | p = 0.008 |
DPT3 | OR | 29.4 | 28.8 | NS | |||
DPT1 | Static | 4.8 | 9.3 | p = 0.002 | |||
DPT1 | OR | 30.4 | 35.2 | NS | |||
Kiyumba | Cross-trained 17 staff on RI techniques; put two vaccinators on duty on days when RIs are administered; reorganized process of RI; expanded involvement of VHTs | Decreased wait time for RI to less than 1 hour from 80% of clients to 20%; VHTs making home visits and identifying unimmunized children | DPT3 | Static | 28.7 | 22.1 | NS |
DPT3 | OR | 20.5 | 21.6 | NS | |||
DPT1 | Static | 22.7 | 25.7 | NS | |||
DPT1 | OR | 18.6 | 22.7 | NS | |||
Kyannamukaka | Ensured that all children receiving services had a child health card; implemented use of registers which included phone numbers, home visits by VHTs, and plan for staff to f/u with caregivers using phone | VHTs visited at least 25 households; have held village meetings; engaged other stakeholders in learning about RI, are referring children to HU; 60 VHTs have been trained by staff; one outreach site has become a static site | DPT3 | Static | 22.8 | 20.3 | NS |
DPT3 | OR | 34.4 | 33.8 | NS | |||
DPT1 | Static | 23.4 | 20.4 | NS | |||
DPT1 | OR | 31.3 | 30.3 | NS | |||
MMC | Increased the number of RI staff to three on most days of the week and to two on outreach days; VHTs were to visit 25 homes, screen all children at static unit for RI status | Improved communication among caregivers, VHTs and staff; developed system for tracking home visits; VHTs identify cases of resistant families and successfully got them to RI; HU working with District leadership to engage other resistant families | DPT3 | Static | 39.1 | 65.3 | p < 0.001 |
DPT3 | OR | 11.7 | 13.0 | NS | |||
DPT1 | Static | 47.0 | 69.7 | p = 0.001 | |||
DPT1 | OR | 12.8 | 10.4 | NS | |||
District health team | Reallocated existing primary care budget to accommodate the purchase of 22 gas cylinders; advocated for purchase by showing no unintended consequences to other services; developed a tracking system to monitor location and use of cylinders | 22 gas cylinders purchased and distributed to HUs with tracking system in place | NA | NA | NA | NA | NA |